Provider Demographics
NPI:1144332487
Name:KANWAL, TEHMINA (MD)
Entity type:Individual
Prefix:
First Name:TEHMINA
Middle Name:
Last Name:KANWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9140 ALCOSTA BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3858
Mailing Address - Country:US
Mailing Address - Phone:925-361-5959
Mailing Address - Fax:925-361-0375
Practice Address - Street 1:9140 ALCOSTA BLVD
Practice Address - Street 2:STE D
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3858
Practice Address - Country:US
Practice Address - Phone:925-361-5959
Practice Address - Fax:925-361-0375
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90031207R00000X
MDD0057389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD685602100Medicaid
MDKDKITEOtherBLUE CROSS BLUE SHIELD
MD88648OtherAMERIGROUP
MD685602100Medicaid
MD88648OtherAMERIGROUP